Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA002456 | GA |
NPI | 1003382649 |
---|---|
Provider Name | Heather Wendell |
First Address | Covington, GA 30016-6212 |
Second Address | Athens, GA 30606-2211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2018 |
Last Update Date | 22/10/2018 |